The goal this project, Dysfunctional Chronic Pain and Chronic Episodes of Care, is to investigate patient and provider factors in the development of chronic episodes of pain-related care among temporomandibular disorder (TMD) pain, headache and back pain patients. Project 1 will use automated event history data on use of doctors and pain medications to study chronic episodes of pain-related care. This research will be carried out in the population of a large health maintenance organization, Group Health Cooperative of Puget Sound (GHC), using its automated health care information systems. The specific aims are to: (1) Develop and maintain a population register of primary care temporomandibular disorder (TMD) pain, headache and back pain patients. This register will identify an estimate 40,000 back pain patients, 14,000 headache patients and 8,200 temporomandibular disorder pain patients over the five years of this project. Automated data on pain-Questionnaire will be administered to 3150 registered cases per year. (2) Develop methods for identifying chronic episodes of care from event history data. Case register data will be used to develop methods of identifying chronic episodes of care from automated health care data. (3) Study the development, determinants and costs of chronic episodes of care. A five year follow-up of primary care back pain, headache and TMD pain patients interviewed on three previous occasions will be carried out (N=1820). These data will be used to study the impact of transient, recurrent and chronic forms of pain dysfunction on care-related pain behaviors, chronic episodes of care and the costs of health care for pain patients. (4) Analyze the development of chronic episodes of care among first treatment pain patients. The predictors and development of chronic episodes of care will be studied among first-treated cases, identified by the case register. (5) Develop and evaluate a provider-based intervention to reduce the occurrence of chronic episodes of care. Primary care practice teams will be randomly assigned to intervention or control groups. Intervention practices will identify dysfunctional back pain patients, provide patient education services to increase patient readiness for self-care, assist patients in developing a Personal Plan for prevention and management of chronic pain dysfunction and provide support for patients in implementation of the Personal Plan. Using case register data, the effects of the intervention will be assessed primarily by reductions in the occurrence of chronic episodes of care and secondarily by pain-related health care costs, patient ratings of the process of care and short-term effects on pain and function.